Patients line up near the registration desk at Great Falls Clinic Immediate Care Center, quietly waiting in line to sign in and see a provider.

The ICC, which staffs two to three providers at all times, stays busy with patients coming in with minor injuries, burns, sore throats, flu-like symptoms, and other episodic ailments.

"Respiratory illnesses are common, as are strains, back injuries, acute fever with vomiting, diarrhea and rashes," said Dr. Terrance Sweeney, a doctor at the ICC.

Sweeney has worked in immediate care for more than 20 years, and it's a field he says keeps his attention – the variety of cases requires it.

But Sweeney also sometimes sees patients whose condition must be treated in an emergency room. A patient having chest pains, for example, might come to ICC trying to downplay symptoms. Sweeney or other providers there make arrangements for them to go to the nearby Benefis Health System Emergency Room.

"I really think, if you're having a heart attack or chest pain, go right to the ER," said Sweeney.

Emergency rooms, or emergency departments, and walk-in care, also called immediate care or urgent care, have been developed to serve two separate patient populations. Emergency rooms are designed to handle patients with life-threatening injuries or illnesses, while walk-in care quickly handles minor but acute illnesses or injuries.

The two are equipped with different capabilities. For example, walk-in care clinics often can do blood draws and lab work, x-rays, testing for illnesses such as influenza or strep throat, and diagnostic evaluation, said Sweeney. But high-level trauma, life-threatening illness, heart attacks or strokes cannot be dealt with in a walk-in care setting.

Federal regulations require ERs to provide care to all patients regardless of extent of their malady or ability to pay.

Sweeney said many patients are good at making the call whether they need to go to walk-in care or the ER, but questions remain among patients, and some patients, according to hospital officials and providers, may wind up in one when they may be better served in the other.

"I'll see anyone. I'm happy to take care of anyone," said Dr. Matthew Newsted, an ER doctor at Benefis Emergency Room.

How patients access care when they need it is of high interested to hospitals like Benefis, which has worked to integrate its Walk-In Care, ER and primary care providers, said Terry Olinger, Benefis Medical Group and System Services President.

The Primary Care Provider

While walk-in care is convenient when a cold becomes a sinus infection or an injury is not serious enough to warrant a visit to the emergency room, providers in family practice argue that becoming established with a doctor is essential to receiving quality care.

Dr. Kris Kuper, a pediatrician at Great Falls Clinic, said the relationships that can grow over time between doctor and patient cannot be duplicated in a walk-in care setting.

"We like to encourage continuity of care, and we know people intimately," said Kuper. "We're possibly getting information the person doesn't even share with a spouse."

Some younger people who do not have ongoing medical conditions choose not to establish themselves with a primary care provider, instead relying on walk-in care when they need it.

Sweeney estimates that about 80 percent of the elderly population has a primary care provider. Perhaps 30 percent of younger people have one, he said.

Knowing the patient as a person and knowing his medical history are valuable tools in treatment, said Dr. Carey Welsh, a family practice doctor at GFC.

Patients should ideally be seeing their doctor once a year for a physical where the physician can go over medical concerns and make sure the patients are on track for cancer screenings that are recommended at certain ages, Welsh said.

In that setting, physicians can look for developmental delays in children or mental health issues across all ages.

There's a place for walk-in care, but Kuper and Welsh don't believe it should stand in for having a primary care provider. But they admit some patients may seek out the ER or walk-in care if they don't realize they can call their doctor's nurse for assistance or an after-hours on-call physician.

"Some people aren't aware how to access health care other than the emergency room," Welsh said.

Welsh said it can be difficult for patients to know what care to seek out. But he said many offices, including his, have nurses who can answer questions over the telephone or page the on-call physician.

Many in health care warn against relying on walk-in care as a stand-in for having a primary care physician. Sweeney suggests anyone with an ongoing condition find a primary care provider. And doing so may lead to "fragmentation" of care, said Benefis Hospitals President Laura Goldhahn.

Emergency Care

Still, many people who go to the emergency room or walk-in care have a primary care provider.

"If your doctor's office is closed or you can't get in, walk-in care would be a good choice – unless you need to go to the ER," said Sweeney.

Newsted said he often spends a lot of time following up with primary care physicians after treating their patients in the ER. At both GFC and Benefis walk-in care clinics, patients who do not have primary care providers are encouraged to consider becoming established with one.

For people who enter the ER but do not have a primary care provider, there is also the post-discharge clinic, a way for the hospital to follow-up with patients after they are discharged from the ER. Newsted considers the post-discharge clinic a good alternative for those patients.

While Newsted is quick to say he is willing to see any patient who walks through the door, he cautions that the ER may not provide the quickest, most cost effective care to everyone.

A patient coming in with a sore throat, for example, is immediately triaged lower than patients who have serious injuries or life-threatening illnesses. As a result, they may wait longer in the ER to see a doctor than they would in walk-in care. Cost for ER services is higher than walk-in care too.

Newsted also pointed out that patients coming in with a condition that needs many tests to diagnose – abdominal pain, for example - may be in for a long visit with many tests.

"I often tell patients you don't want me to dig any deeper, run a lot of tests," he said. "I have to know when to refer to their primary care or admit to the hospital" to get to the bottom of the problem.

The ER at Benefis sees between 35,000 and 38,000 patients each year. About one-third of those could have been seen in a walk-in setting, according to Newsted.

During times when walk-in clinics are closed, the ER is the only option. At that point, Newsted urges anyone who thinks they may need to be seen to come in.

The ER sometimes gets calls from patients wondering if they need to come in. They speak to a unit clerk and sometimes may be able to get to a nurse, if time allows. But Newsted said triaging an emergency over the telephone is difficult and fraught with legal peril.

"When in doubt, just come in," he said.

He said chest pains, suspected strokes, head injuries, fractures, and anyone with complex medical history should definitely come in to the ER, he said.

But Newsted also encourages people to use their best judgment and come when they think they should.

"We really do want people to go to the appropriate level of care at the right time," said Olinger.

When to Go

The Benefis Health System Emergency Room is open 24 hours a day, seven days a week, 365 days a year. It is located on the Benefis East campus and can be reached by turning south off 10th Ave South onto 26th Street S, and then turning east on 11th Ave South.

Benefis Walk-In Care is open Monday through Friday 7 a.m. to 8 p.m., and Saturday and Sunday 9 a.m.to 6:30 p.m. and is located at 1401 26th St S.

The Great Falls Clinic Immediate Care Center's hours are Monday through Friday, 7 a.m. to 7 p.m., Saturdays 8 a.m. to 6 p.m. and Sundays and holidays 9 a.m. to 4 p.m. The ICC is closed Easter, Thanksgiving and Christmas. It is located at 1400 29th St. S. The Great Falls Clinic Northwest also accepts walk-in patients Monday through Thursday, 8 a.m. to 7 p.m. and Friday, 8 a.m. to 5p.m., and it is closed on holidays. That clinic is located at 1600 Division Road.

Where to Go

Benefis' ER is a Level II trauma center staffed by board-certitfied or board-eligible physicians. An ER minor section of the department is staffed from noon to midnight each day and treats non-emergent needs. Patients experiencing chest pains, stroke-like symptoms or major trauma, including a head injury, or those who are ill and have a complex underlying condition such as cancer, heart disease or renal disease should go to the ER right away or call 911.

Walk-in care at Benefis and GFC routinely sees patients with sprains and other minor injuries, influenza, infections, strep throat, asthma, some fractures, and other non-chronic illnesses. Newborns experiencing fever, illness or injury should go to the ER, but Sweeney said infants a few months old and older can usually be seen in walk-in care for moderate fevers. Lab testing and x-rays can be performed at walk-in clinics also.

Benefis Injury Center near its Walk-In Care, where patients with sprains, strains or sports-related injuries can be seen. The hours are Monday through Friday, 8 a.m. to 6 p.m.

An after-hours pediatric line for parents with questions is 731-8865.

Benefis Medical Group has begun a patient navigator to help patients find a primary care doctor. The number is 731-8896.

But doctors urge patients that, if in doubt about where they should seek care, go to the emergency room first.

Sweeney also suggests patients bring a list of medications and cursory medical history with them to their walk-in care visit, if they have the information available.